1306933460 NPI number — PAGAL OPTICAL, INC.

Table of content: (NPI 1306933460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306933460 NPI number — PAGAL OPTICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAGAL OPTICAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PEARLE VISION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306933460
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3349 MONROE AVE
Provider Second Line Business Mailing Address:
PITTSFORD PLAZA
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14618-5513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-381-1616
Provider Business Mailing Address Fax Number:
585-381-0718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3349 MONROE AVE
Provider Second Line Business Practice Location Address:
PITTSFORD PLAZA
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14618-5513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-381-1616
Provider Business Practice Location Address Fax Number:
585-381-0718
Provider Enumeration Date:
10/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VARIN
Authorized Official First Name:
SELES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
585-381-1616

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  4996 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 102136 . This is a "EYEMED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: FAO139 . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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